Seven reasons why GP consultations are getting more complex

General practice has become more clinically complicated, alongside the diminishing workforce and increasing demand. Jo Best explores the causes—and possible solutions Steve Taylor has been a GP for almost 30 years, first as a partner and now as a locum. “When I started, 20% of my patients were on some sort of medication; now it’s 50%,” says the Manchester based GP. “Now, you’ve got access to more investigations that you wouldn’t have had as a GP 20 years ago, and you’ve got more drugs that you can use. “There’s been a huge increase in complexity. Obviously, there’s always been complex cases, but the depth of that has just increased as time has gone by.” He’s not alone: ask a GP if their work has become more complex over time, and you’ll almost certainly be met with a yes. More patients than ever are registered with GPs, while appointments aren’t rising in parallel, leaving GPs’ workloads spiralling. Taylor says, “When I started 30 years ago, I’d do a two hour clinic in the morning and a two hour clinic in the afternoon. I’d do some admin and some visits in the middle, but it was pretty much a 9 to 5 30-ish day. After 30 years in the business I was starting at 8 am, finishing at 7 30 pm, and not stopping for a minute.” But increasing complexity is more than just a side effect of increased demand on primary care: demographic changes and shifts in the nature of GPs’ roles have caused an increase in the levels of complexity GPs now see every day. Gauging change in complexity comes with challenges. There’s little agreement on how to define complexity in primary care and few validated tools for measuring it. A recent consensus statement1 attempted to define complex consultations as “those …